过期与延期妊娠的胎盘床血管和胎盘形态计量学

Morphometrical study on uteroplacental vessels and placenta in prolonged and delayed pregnancies

本文应用图像分析技术对过期妊娠２０例（过期组）、延期妊娠１５例（延期组）和正常足月妊娠２９例（正常组）的胎盘绒毛和胎盘床螺旋小动脉进行形态计量学检测。结果：（１）过期组胎盘绒毛具有合体细胞结节、细胞滋养细胞增生、绒毛基底膜增厚和纤维素样坏死的绒毛数高于正常组（均Ｐ＜００５），血管合体细胞膜形成的绒毛数低于正常组（Ｐ＜００５）；延期组与对照组和过期组间均无显著区别。（２）过期组胎盘绒毛直经、周长和面积参数均小于正常组（均Ｐ＜００１）；延期组仅周长和面积参数小于正常组（Ｐ＜００５）。（３）过期、延期组胎盘床螺旋小动脉管壁增厚者高于正常组（Ｐ＜００５），而妊娠生理性改变、管壁纤维素样坏死以及急性动脉粥样化病变与对照组无明显区别。（４）过期、延期组羊水过少和羊水粪染的发生率高于正常组（均Ｐ＜００５），而新生儿低评分者发生率较高，但与正常组无明显区别。提示：过期和延期妊娠的子宫胎盘床血管和胎盘绒毛的形态学病变是导致胎盘功能逐渐低下以及胎儿预后不良的主要原因。

To study the morphological characteristics of the placental villi and uteroplacental helicine arteries in the prolonged and delayed pregnancies and the relationship to fetal prognosis, 20 cases with prolonged pregnancies (PP), 15 cases with delayed pregnancies (DP), and 29 cases of normal term pregnancies (NTP)were examined by image analysis. Results:(1)The numbers of the placental villus with the syncytial knots, cytotrophoblasts, thickening of basal lamina and fibrinoid necrosis in both PP and DP groups were higher than those in NTP (P<005 for all).And the numbers of the placental villus with the vasculosyncytial membranes in both groups were significantly lower than those in NTP(P<005). (2)The diameter perimeter and area of the placental villus in PP were lower than those in NTP (P<001 for all ),and the perimeter and area in DP were lower than those in NTP (P<005). (3) The incidence of the wall thickening of the spiral arteries of the uteroplacental bed in both PP and DP groups was higher than those in NTP (P<005),but there were no significant differences in physiological pregnant changes,fibrinoid necrosis,and acute arterial atherosis of the vessels between these two groups or NTP respectively.(4)The incidences of the oligoamnios and amniotic fluid feces staining in both PP and DP groups were higher than those in NTP.Conclusions:Th morphological characteristics of the uteroplacental helicine arteries and placental villi in the prolonged and delayed pregnancies may be the major reasons of the placental insufficiency and unfavourable fetal prognosis,especially in PP.